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MR. ROBERTSON: We have not a very large out-door department at the Children's Hospital. This year it will run up to over 10,000—but we have a man clerk, sometimes one of the dispensary nurses, who in a kindly and courteous way questions those applicants that come for aid with their children. On the second application the parent must bring a certificate signed by a clergyman or well known citizen. Some years ago we felt that there was an amount, not very large, but still an amount, of imposition that should not exist in connection with our dispensary and I adopted a plan of inquiry. Every year during the past four or five years, for two or three months, I have taken 100 names from the lists in the outdoor department, and also 100 or more names of the free indoor patients whose homes are in Toronto, and an inspector calls on each of these. Our inspector found that not more than five per cent could pay more than a trifle. That is our experience, and is the result of the last investigation that was reported about six weeks ago.

In connection with the indoor department we find that there are not very many that can pay more than the $4.75 a week, our free ward rate. Of course where patients on certificate cannot afford to pay, they are treated free. The result of our examination has been in favor of the patient and shows that there is not as much imposition as a great many people think in connection with our free or partly free work. I agree with what Dr. Kavanagh and Miss Banfield state, that we should not judge people by their clothing. We should rather be very kindly and considerate and endeavor in as courteous a manner as possible to obtain the information required and act accordingly. I do not know that our system of inspection to which I have referred could be worked out as easily in New York or Boston or Philadelphia, but certainly it has worked out well here, and with most satisfactory results.

292

THE PRIVATE HOSPITAL AS A

MUNICIPAL AGENT.

Dr. D. C. POTTER,

Chief Charitable Institutions Bureau, Department Finance,

New York City.

(By Invitation.)

No community has “found itself” until it has discovered that its most precious asset is human life. Failure to recognize the principle that life only is important has been the most ruinous of all mankind's many blunders, the most dreadful of all his disasters. We have repeatedly paid too dearly for both the accessories and conveniences of civilization because we did not discover that the use of what seemed to be epoch-marking invention or improvement could destroy the life that tried it.

Most communities are long on experience. However dear it may be, we pay and must keep on paying for the whistle.

Our normal community, be it a village, city or metropolis, having wrestled with its economic problems, having wept long in its graveyards because it feared the cost of good sewers, having had its public funerals and erected expensive monuments to its victims because its uninspected buildings fell down or its insecure bridges caved in, or maybe its board of health instead of protecting its water supply went off to a hospital convention while typhoid ravaged its homes, well, this expanding community bearing in mind all it knows and how much its knowledge in all kinds of ways has cost, now says most everywhere these days, "We will protect life-life, which no man can give; life, which any fool can destroy ; life, your life, my life, our life.

The community says to protect and save endangered life we will support hospitals, we will create more hospitals.

Our question, How shall we do it? What method shall we follow?

Two courses are open to the normal community.

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One is, cry for hospitals and turn the whole question of providing them over to civic government, the city fathers, the mayor and aldermen, and as political life in the town goes up and down all parties in time can take a hand in developing and managing the civic hospital and in creating a system. Hospitals of that foundation are likely to have their vicissitudes. They will have times of needless enlargement (for political purposes only) and waste in care and management. They will see seasons when a revolutionary or a reform party will come into power to “turn the grafters out" and some watchdog of the city treasury will economize. Under his drastic and Spartan administration fresh air will be dear and fresh bandages will be impossible.

Most of us have seen this thing in all its forms. If there was no great burden to the taxpayer, no needless suffering to the poor and wounded and no need for progress as an exhibition in sociology and civics, including crime, perhaps, the too general rule is good enough to be let alone.

There is no hippodrome of mirth so funny or so senseless as the general run of city governments and sometimes they are tragic.

This whole question of hospitals in general, their development, use and maintenance, can be illustrated in the concrete by an outline of the hospital situation in New York, with which I am fairly familiar.

Lest you should misapprehend, let me say in the language of the time, I am not a "knocker.” The citizen of our metropolis who goes abroad to defame it would better conceal his identity. There is no greater or better city and none nobler. Looked at from any point of view, its rivals are few on this old globe and it is the truth to say its citizens would rather be the slaves of the typical grasping landlord and live, than to dwell rent free anywhere else under the sun and exist, nursing forever an unutterable longing to get back to Broadway or the Bowery. But we have sense enough to see ourselves as we are and sense of humor enough to talk about it. It is more than likely if a stranger were to say as much we would fight.

As the result of a plan where through all its life the city developed a system of public hospitals-meaning those directly created and maintained out of public funds-prior to 1900 we had a string of hospitals all under the control of the Department of Public Charities. It is more than probable that they needed bettering to a considerable degree —reforming, in fact.

Now, the modern public dearly loves a reformer. Reformers in our town are essentially luxuries. Luxuries are always expensive. My observation is that genuine reformers, the Simon-pure, up-to-date article, generally reforms in the interest of the reformers. It's a rare experience when the community or subject of reformation gets the best end of the change; the poor old taxpayer who had one burden before the reform afterward always has three-support of the old things, support of the reformer and support of the new and more expensive system. It always costs more to support any civic enterprise after it has been reformed. It is wonderful how gullable the poor public continued to be, how hopeful of betterment under change. Because hope springs eternal in the taxpayer's breast, the reformer springs eternally on the taxpayer.

Canada for years has sent us a very large proportion of all the trained nurses educated in our city training schools. They are splendid types of young womanhood and become the best of good nurses. I modestly suggest that Canada might send us a few reformers. The city latchstring is always out. Reformers come to us from the hamlets of far western states. Having been brought up in obscurity and the empty places and having had no experience in life, they know best of all what is suited to the congested districts in the metropolis.

As an illustration, one of our prominent reformers drifted in from the West three or four years ago, became the secretary of one of our old relief societies at a good salary, started in to reform that society by bouncing the old employes, and as soon as he was landed comfortably began to sell disinfectants to our charitable institutions as a side line on the quiet! Today he heads a widely advertised reform society at a still larger salary, and hopes for better things. And there are others.

Our Canadian friends should not neglect the virgin field of municipal reform in the cities of the States. Nothing pays like professional philanthropy and the only capital required is carried under your hat.

THE HOSPITAL SYSTEM IN THE METROPOLIS WAS REFORMED.

Because no one of consequence opposed it, the State Legislature kindly divided the hospitals up and now by law we have a three-headed system of hospital management as follows:

One. The Public Charity Department has control of the general City, Metropolitan and Tuberculosis Hospitals on Blackwell's Island, the Children's Hospital on Randall's Island, the Kings County Charity Hospitals, the Cumberland and Bradford Street Hospitals, the new Coney Hospital and the new Seaview Hospital in the borough of Richmond. These latter two are now under construction.

Two. Trustees of the Bellevue and Allied Hospitals. These have the old Bellevue Hospital at the foot of East Twenty-sixth street, the Gouveneur Hospital, Fordham Hospital and Harlem Hospital.

Three. The Board of Health has the Willard Parker in Manhattan, Kingston Street in Brooklyn, and the North Brother Island Hospitals, all for contagious diseases.

Now, I would not characterize the brand of personal patriotism which inspired the disruption of our public hospital management prevailing prior to 1900. If the way to develop and improve a public hospital system is to separate or divide it, then it should be separated and divided still further. It has never been clearly shown that progress is developed through the intervention of disintegration and chaos.

At the present moment we have a trinity of opposing interests, each seeking its own aggrandisement at the expense of the city. The under dog is the taxpayer and in this matter he has no friends.

I would not recommend our municipal system of manag. ing public hospitals to any civic community.

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